Vol 29, No 1 (2024)

BACKGROUND: Acute leukemia is the commonest malignancy of childhood with an incidence rate of about 55–62 per 1 million under 18 years of age. Early diagnosis of acute leukemia is difficult due to the non-specificity of primary symptoms, which are often hidden under the “masks” of other diseases. This problem is especially relevant for regions with a population of up to 100 thousand people, where a case of acute leukemia in children occurs every 2–5 years causing too low oncological alertness among pediatricians.

AIM: Assess the delay in diagnosis depending on the areas of residence in the Tver region and area remoteness from the Tver Regional Clinical Children’s Hospital (Tver, Russia).

MATERIALS AND METHODS: The analysis included 35 patients hospitalized in the Department of Oncology and hematology of the Tver Regional Clinical Children’s Hospital for the period from 2018 to 2023. The diagnoses were: acute lymphocytic leukemia (C91.0) — 30 (86%) patients, acute myeloid leukemia (C92) — 3 (9%) patients, and acute leukemia of unspecified cell type (C95.0) — 2 (5%) patients. The mean age was 61 months (5.1 years). Thrombocytopenia and anemia at the time of diagnosis were found in 76% and 78%, respectively. Leukocytosis (> 20×10⁹/L) was observed in 58%, leukopenia (<3.5×10⁹/L) in 15% of patients. In 97% of cases blasts (2% to 95%) were detected in peripheral blood. In the city of Tver (Group 1) and the Tver region (Group 2), 16 (46%) and 19 (54%) patients were identified, respectively. The mean age of patients in Group 1 is 28.6 months, and in Group 2 — 72.3 months (p=0.1).

RESULTS: In Groups 1 and 2, acute lymphocytic leukemia was diagnosed in 14 (88%) and 16 (84%), respectively (p=0.6); acute myeloid leukemia — in 1 (6%) and 2 (11%), respectively (p=0.7); acute leukemia of unspecified cell type — in 1 (6%) and 1 (5%) cases, respectively (p=0.95). Delay of diagnosis in the general group (n=35) was observed as follows: <2 weeks — in 21 (60%) cases; 2–4 weeks — in 7 (20%) cases; 4–8 weeks — in 4 (11%) cases: >8 weeks — in 3 (9%) cases. Comparison of the time of delayed diagnosis among patients living in the city of Tver versus the Tver region yielded following results: <2 weeks in 7 (44%) vs 13 (68%) cases; 2–4 weeks — in 6 (38%) vs 3 (17%), 4–8 weeks — in 1 (6%) vs 1 (5%); >8 weeks — in 2 (12%) vs 2 (10%) cases, respectively (p=0.37). There was no significant impact of the distance of the residence place from the level 3 children’s hospital providing specialized care on the time of diagnosis. With the patients’ distance of <50 km from the clinic, the diagnosis delay of <2 weeks, 2–4 weeks, 4–8 weeks and >8 weeks was observed in 36%, 36%, 21% and 7% of cases, respectively. With the distance of 50–100 km, the diagnosis was made in the period of 2–4 weeks in 100% of cases. With the removal of >100 km the diagnosis delay of <2 weeks, 2–4 weeks, 4–8 weeks, >8 weeks was observed in 30%, 30%, 20% and 20%, respectively (p=0.78).

CONCLUSION: The distance from the third-level hospital did not affect the period of diagnosis of acute leukemia in children. We believe this is achieved by holding daily on-line conferences with country hospitals and out-patient departments followed by the rapid hospitalization of children with suspected oncohematological disorders in the specialized department.

BACKGROUND: The main complication of surgical pancreas interventions is the pancreatic fistula (PF) — abnormal secretion of pancreatic secretions into the abdominal cavity, which can lead to more severe complications. At the same time, some predictors of PF remain poorly understood.

AIM: To investigate the risk factors for the development of PF after distal pancreatic resection.

MATERIALS AND METHODS: The study included 40 patients who underwent distal resection. The influence of various clinical parameters on the development of PF after surgery was evaluated. Methods of mathematical modeling and correlation analysis were used. Mathematical modeling was carried out using the Random forest machine learning algorithm, and the indicator of the relative importance of the “importance” parameters was evaluated.

RESULTS: According to the Random forest model, on day 1 after surgery, the most significant predictors of the development of PF were: the volume of neoplasm, age and stage of the oncological process, for which “importance” was 53.2, 13.7 and 12.5 (AUC ROC=62%); on day 3–5, “importance” was 61.7, 11.5 and 5.2 (AUC ROC=79%). An increase in the concentration of pancreatic amylase in blood plasma for 2–3 and 3–5 days correlated with its increase in the drainage discharge for 5-7 days after the intervention (r=0.48 and 0.76; p <0.05). A correlation was found between the level of amylase in the drainage discharge on 3–5 days after the intervention and the level of leukocytes according to the general blood test (r=0.62, p <0.05).

CONCLUSION: An increase in plasma amylase levels is the main risk factor for the development of PF. An increase in the concentration of amylase in the drainage discharge can be considered as a potential risk factor for the development of pancreatic fistulas with clinical manifestations in the following days. The stage of the oncological process, the size of the neoplasm and the age of the patient are also risk factors.

BACKGROUND: Diagnosis and treatment of patients with colorectal cancer is a multidisciplinary task. The transition to a new edition of clinical guidelines for the treatment of colorectal cancer in 2024, while maintaining the routine approach to MR staging of malignant neoplasms of this localization, reduces the level of continuity between medical specialists.

AIM: To improve the quality and completeness of MR diagnostics of malignant neoplasms of the rectum to ensure continuity and improve the multidisciplinary approach.

MATERIALS AND METHODS: A retrospective analysis of the completeness of compliance with the parameters of TNM 8 (2017) and the MRI subclassification T3 of rectal cancer was carried out on 137 MRI scans of the pelvic organs and protocols with conclusions to them. Based on the results of the analysis, educational training and a conclusion template for radiologists were developed and conducted, after which the MR images were re-evaluated. Before and after the training, the most fully evaluated MRI scans by radiologists were provided to medical experts to form a “second opinion”. The results obtained made it possible to calculate the absolute and relative number of consensuses (coinciding in all parameters of the conclusions) and to identify cases of rectal cancer restaging that require changes in treatment tactics.

RESULTS: Before the educational training, only 11% of MRI scans and their reports met the requirements of the modern protocol. After the training, 78% of the images were completed in compliance with all requirements. Particular difficulties and the majority of “discrepancies” in conclusions arose when determining the depth of tumor invasion into the mesorectal tissue; measuring the distance from the tumor and/or affected lymph node to the mesorectal fascia or edge of the levator ani muscle and identifying signs of extramural vascular invasion. It was not possible to achieve complete consensus in all cases on these parameters.

CONCLUSION: The analysis of MRI scans of the pelvic organs, the development and implementation of educational training to improve the interpretation of medical images, made it possible to significantly improve the staging of rectal cancer and ensure proper continuity in the implementation of a multidisciplinary approach.

The review analyzes the results of conservative therapy of patients with the head and neck cancer. Despite the use of modern radiation and drug technologies, the results of treatment of locally advanced forms of head and neck cancers and relapses are not satisfactory. The most effective is the simultaneous use of modified radiation and chemotherapy regimens. However, the implementation of the treatment plan with this method is limited to the development of pronounced early and late toxic effects on normal tissues and organs. The radiosensitizing effect of targeted therapy was also analyzed.